Chondrosarcoma: Symptoms, Causes, Diagnosis, and Treatment - Aaron Cohen-Gadol, M.D.

Summary

Neurosurgeon Dr. Aaron Cohen Gadol discusses chondrosarcomas, rare skull-based tumors arising from cartilage cells. He explains these slow-growing but locally aggressive tumors, often recurring post-resection due to their adherence to surrounding structures. Common symptoms include visual issues, headaches, and hearing loss. Diagnosis involves CT scans, MRI, and possibly biopsies. Treatment primarily consists of surgical resection, supplemented by radiation and occasionally chemotherapy. Despite recurrence in 80-90% of cases, the five-year survival rate is positive, emphasizing the importance of specialized neurosurgical and skull-based expertise.

Takeaways

• 🧠 Chondrosarcomas are rare skull-based tumors that arise from cartilage cells of the bone.
• 🔄 These tumors grow slowly but can be locally aggressive and often recur after initial resection due to their tendency to adhere to surrounding structures.
• 📈 Chondrosarcomas are less aggressive than chordomas but share similarities in location and nature.
• 🏥 The incidence rate is very low, affecting one in 200,000 patients per year, and is more common in adults aged 40 to 70.
• 👀 Symptoms of chondrosarcoma can include visual problems, headaches, vertigo, hearing loss, numbness, difficulty swallowing, and facial pain.
• 🏥 For spinal location, symptoms may include lower back pain, numbness, changes in bowel or bladder function, and mobility issues.
• 🛄 Diagnostic tests typically involve CT scans for bone evaluation and MRI for soft tissue examination around the bone.
• 🔍 A biopsy may be performed prior to resection to confirm the diagnosis and assess the tumor's growth rate.
• ⚕️ Treatment options include surgical resection, radiation therapy, and chemotherapy, often used in combination.
• 👨‍⚕️ Surgical resection is the primary and most effective treatment, with surgeons often using a transveneral or craniotomy approach depending on the tumor's location.
• 💡 Adjuvant therapies like external beam radiation, proton beam radiation, and radiosurgery are used post-surgery to target residual tumor cells.
• 💊 Chemotherapy is rarely used for chondrosarcomas and is typically reserved for patients with advanced disease.
• ⚠️ Complications of surgery can include brain fluid leaks, loss of function in various bodily systems, and cranial nerve abnormalities.
• 🌟 The prognosis is positive, with approximately 80-90% of patients surviving and maintaining functional status at five years post-treatment.

Q & A

What is a chondrosarcoma?

Chondrosarcomas are rare skull-based tumors that arise from the cartilage cells of the bone. They are slow-growing but can be locally aggressive and often recur after initial resection.

How rare are chondrosarcomas?

Chondrosarcomas are very rare, affecting approximately one in 200,000 patients per year or one in a million in the population.

What age group is more commonly affected by chondrosarcomas?

Chondrosarcomas are more commonly seen in older adults, specifically between the ages of 40 and 70.

What are some common symptoms of chondrosarcomas?

Common symptoms include visual problems such as double vision, headaches, vertigo, hearing loss, numbness, difficulty swallowing, and facial pain. For tumors at the spine level, symptoms can include lower back pain, numbness, changes in bowel function, and mobility issues.

What diagnostic tests are typically used for chondrosarcomas?

Diagnostic tests include computer tomography (CT) scans to evaluate the bone and magnetic resonance imaging (MRI) to review the soft tissues around the bone and see the extent of the tumor. Sometimes a biopsy is performed before resection to confirm the diagnosis and assess the tumor's growth rate.

What are the treatment options for chondrosarcomas?

The treatment options for chondrosarcomas include surgical resection, radiation therapy, and chemotherapy. Surgical resection is the primary and most effective treatment, with the goal of removing as much of the tumor as possible.

How is the surgical resection of a chondrosarcoma typically performed?

The surgical resection is often performed through a transveneral operation, where the surgeon goes through the nose. In some cases, a craniotomy may be performed to remove a piece of the skull and residual tumor.

What is the role of radiation therapy in the treatment of chondrosarcomas?

Radiation therapy, including external beam radiation or proton beam therapy, is applied to the tumor bed after resection. It usually involves visits five times a week for several weeks.

Is chemotherapy commonly used for chondrosarcomas?

Chemotherapy is rarely used for chondrosarcomas, as it is typically reserved for patients with advanced disease where the tumors are rapidly dividing.

What are some potential complications of chondrosarcoma surgery?

Complications can include brain fluid leak through the nose, loss of bowel or brain function, loss of sexual function, pituitary function failure, numbness, movement problems, double vision, or other cranial nerve abnormalities.

What is the general prognosis for patients with chondrosarcomas?

The outlook is positive, with approximately 80 to 90% of patients surviving and having a functional status at five years post-treatment.

Why is it important for patients with chondrosarcomas to see experienced specialists?

It is important because the surgical anatomy in the region is very complicated, and maximizing tumor removal requires many years of experience on behalf of the surgeons involved.

Outlines

00:00

🦴 Chondrosarcoma Overview and Management

Dr. Aaron Cohen Gadol, a neurosurgeon, introduces chondrosarcomas as rare skull-based tumors arising from cartilage cells. He discusses their slow growth and potential for recurrence due to their invasive nature. Chondrosarcomas are less aggressive than chordomas and predominantly affect individuals aged 40 to 70. Common symptoms include visual problems, headaches, vertigo, hearing loss, and facial pain. Diagnostic tests such as CT scans and MRIs are used to assess the tumor's extent. Treatment primarily involves surgical resection, with the goal of removing as much of the tumor as possible, often through minimally invasive transvaginal operations or craniotomies. Additional treatments may include radiation and chemotherapy, though the latter is rarely used. The doctor emphasizes the importance of experience in managing these tumors.

05:01

🌟 Post-Treatment Expectations and Surgical Challenges

The second paragraph focuses on the positive outlook for chondrosarcoma patients, with an 80 to 90 percent survival rate at five years. Dr. Cohen Gadol advises discussing post-treatment expectations with experienced surgeons and oncologists. He highlights the complexity of skull-based surgery and the need for extensive surgical experience to maximize tumor removal. The paragraph concludes with the doctor's willingness to be involved in patient care and a reminder of the importance of specialized care in managing these rare tumors.

Keywords

💡Chondrosarcomas

Chondrosarcomas are a type of cancer that originates from cartilage cells within the bones. They are slow-growing but can be locally aggressive, often recurring after initial resection due to their tendency to adhere to surrounding structures. In the video, Dr. Aaron Cohen Gadol discusses his experience managing these rare skull-based tumors, emphasizing their rarity and the challenges they present in treatment.

💡Neurosurgeon

A neurosurgeon is a medical professional who specializes in the diagnosis and treatment of disorders affecting the brain, spinal cord, and peripheral nerves. In the script, Dr. Aaron Cohen Gadol introduces himself as a neurosurgeon, indicating his expertise in the field and his role in managing chondrosarcomas.

💡Skull-based tumors

Skull-based tumors refer to growths that occur within the skull, often affecting the brain or surrounding structures. In the video, the focus is on chondrosarcomas as a specific type of skull-based tumor, highlighting their unique characteristics and treatment approaches.

💡Resection

Resection in medical terms refers to the surgical removal of a part of the body, such as a tumor. The script mentions that chondrosarcomas can be difficult to remove completely due to their adherence to surrounding tissues, which can lead to recurrence even after resection.

💡Chordomas

Chordomas are another type of bone tumor, similar to chondrosarcomas in that they occur in the skull base or spine. However, they are noted to be less aggressive than chondrosarcomas. The video script uses chordomas as a comparative reference to describe the nature of chondrosarcomas.

💡Symptoms

Symptoms are the signs and indications of a disease or condition. The video lists various symptoms associated with chondrosarcomas, such as visual problems, headaches, and hearing loss, which can help in diagnosing the condition.

💡CT Scan

A CT (Computed Tomography) scan is a medical imaging technique that uses X-rays to generate cross-sectional images of the body. In the context of the video, a CT scan is used to evaluate the bone structure of the skull or spine in patients with chondrosarcomas.

💡MRI

MRI (Magnetic Resonance Imaging) is an imaging technique that uses magnetic fields and radio waves to create detailed images of the body's soft tissues. The script mentions the use of MRI to assess the extent of a tumor around the brain in cases of chondrosarcomas.

💡Biopsy

A biopsy is a medical procedure that involves taking a sample of tissue for examination to confirm a diagnosis. The video script notes that a biopsy may be performed before resection to confirm the diagnosis of a chondrosarcoma and to assess its growth rate.

💡Surgical Resection

Surgical resection is the primary treatment for chondrosarcomas, as mentioned in the script. It involves the removal of the tumor, with the goal of maximizing the amount of tumor tissue removed while preserving as much healthy tissue as possible. The approach to surgical resection can vary based on the tumor's location.

💡Radiation Therapy

Radiation therapy is a treatment method that uses high-energy radiation to target and destroy cancer cells. The script describes external beam radiation and proton beam therapy as modalities used post-surgery to treat the tumor bed in chondrosarcoma cases.

💡Chemotherapy

Chemotherapy is a type of cancer treatment that uses drugs to kill or inhibit the growth of cancer cells. The video script mentions that chemotherapy is rarely used for chondrosarcomas, typically reserved for patients with advanced disease where the tumors are more rapidly dividing.

💡Complications

Complications refer to any unfavorable or unintended outcomes that may arise as a result of a medical procedure or disease. The script outlines potential complications of neurosurgery for chondrosarcomas, including issues like brain fluid leaks, loss of function, and cranial nerve abnormalities.

💡Survival Rate

Survival rate is a statistic that indicates the percentage of patients who survive a certain period of time after diagnosis or treatment. The video script provides a positive outlook, mentioning that approximately 80 to 90 percent of patients with chondrosarcomas survive and maintain functional status at five years post-treatment.

Highlights

Chondrosarcomas are rare skull-based tumors arising from cartilage cells of the bone.

They are slow-growing but can be locally aggressive and often recur after initial resection.

Chondrosarcomas are similar to but less aggressive than chordomas, another type of bone tumor.

These tumors typically occur at the skull base or the lower portion of the skull and near the spine.

Chondrosarcomas affect approximately one in 200,000 patients per year.

Symptoms include visual problems, headaches, vertigo, hearing loss, numbness, and facial pain.

Spinal chondrosarcomas may present with lower back pain, numbness, and changes in bowel and bladder function.

Diagnostic tests include CT scans, MRI, and sometimes a biopsy to confirm diagnosis and assess tumor growth rate.

Treatment options for chondrosarcomas include surgical resection, radiation, chemotherapy, and a combination of these.

Surgical resection is the primary and most effective treatment, with surgeons often using a transveneral approach.

In some cases, a craniotomy may be performed to remove residual tumor after initial resection.

External beam radiation or proton beam therapy is applied post-surgery to target the tumor bed.

Radiosurgery involves concentrated beams of radiation and is usually performed in less than an hour.

Chemotherapy is rarely used for chondrosarcomas due to their slow-dividing nature.

Complications of chondrosarcoma surgery include brain fluid leak, loss of function, and cranial nerve abnormalities.

Approximately 80-90% of patients survive with functional status at five years post-treatment.

Specialized care from experienced neurosurgeons and head and neck surgeons is crucial for optimal outcomes.

The surgical anatomy in the region is complex, requiring extensive experience for successful tumor removal.

Transcripts

[Music]

hello ladies and gentlemen my name is

aaron cohen gadol i'm a neurosurgeon i

want to talk to you today about

chondrosarcomas these are very rare

skull-based tumors

and i've been involved in the management

of this tumor type for many years

and therefore we'd like to review these

tumors and provide you with additional

information to

make your journey if you're undergoing

treatment more

efficient and

easier

chondrosarcomas are tumors that arise

from the cartilage cells of the bone and

they're relatively slow growing tumors

but can be locally aggressive and often

recur after initial resection that's

because these tumors although slow

growing can stick to their surrounding

structures and make it very difficult to

remove them completely

they are similar but less aggressive

than chordomas there are similar type of

tumors they're in the bone at the level

of skull base or lower portion of the

skull and again typically they occur at

the level of skull

and

bottom of your spine

so chondrosarcomas fortunately are very

rare they affect one in 200 000 patients

per year or one in a million

in population uh

carry such a tumor they are more

commonly seen in older adults and

specifically between the ages of 40 and

70.

what are the symptoms

that can lead you to diagnose some

chondrosarcoma typically visual problems

such as double vision headaches vertigo

or balance difficulties

hearing loss numbness difficulty

swallowing and facial pain

the common symptoms of these tumors

at the level of spine can be lower back

pain or numbness changes in bowel

function

incontinence impotence in email and

changes

in mobility and walking

what are the tests that we typically use

is a computer tomography or ct scan that

evaluates the bone out of a skull or

spine

as well as magnetic resonance imaging or

mri that can help us

review the soft tissues around the bone

and see the extent of the tumor

around the brain

sometimes we may perform a biopsy before

we do the resection to confirm the

diagnosis and assess the exact growth

rate of the tumor

the three options or maybe four for four

quantum sarcomas are surgical resection

as the primary route of treatment

radiation or chemotherapy and in fact

it's the treatment involves essentially

all three of these together at some

point

so

the surgical part of the treatment is

the primary mode of treatment and it's

the preferred one it's most effective

among the other treatment modalities the

goal is to remove as much of the tumor

as possible and typically the surgeon

goes through the nose through a

transveneral operation and surgeon has

to have extensive experience in this

area

and this minimally invasive way provides

a very effective route for removal of

the tumor based on location of the tumor

the surgeon may also perform a

craniotomy in order to

remove a piece of the skull at a later

stage to remove the residual tumor

the other modalities are external beam

radiation or proton beam where high

energy radiation is applied to the tumor

bed after a section is performed and

usually takes about five times a week

visits for several weeks and also

radiosurgery which is a concentrated

concentrated beams of radiation may be

applied and usually it takes about less

than an hour to perform

chemotherapy is rarely used for

chondrosarcomas they may you would be

using patients with advanced disease

and um

chemotherapeutic agents usually target

rapidly

dividing tumors in other words those

rare types of tumors that are

the cancerous forms of the tumors

and that really rarely occurs among

chondrosarcomas

complications of transfer neural surgery

involved brain fluid leak through the

nose loss of bowel or brain function

loss of sexual function pituitary

function failure numbness

movement problems or

double vision or other cranial nerve

abnormalities

so these tumors are slow growing but

they recur

approximately 80 to 90 of the patients

are surviving and having functional

status at five years so again the

outlook is very positive you have to

discuss your expectations after

treatment with your surgeon specifically

and make sure you see care from

oncologists and skull-based surgeons in

other words neurosurgeons and head and

neck surgeons with extensive experience

in this area the surgery can be quite

challenging the surgical anatomy in the

region is very complicated and be able

to maximize tumor removal requires many

years of experience on behalf of the

surgeons involved again thank you for

listening and i'm more than honored to

be involved in your care anytime

possible thank you

[Music]